Probabilistic graphical modelling of early childhood caries development.

In order to develop a statistical model for complex interactions among factors affecting early childhood caries development (ECC), 234 children from the "XXXX oral growth longitudinal study" were analysed at ages 3, 4 and 5. A questionnaire for children's parents (clinical history, nutritional and oral hygiene habits) and clinical oral examinations were recorded each year. The probabilistic dependence structure on the most significant factors was modelled with an Undirected Graphical Model (UGM or Markov random fields) which provides a probabilistic reasoning approach for the establishment of multi-way associations. The best fitting UGM was estimated through the maximum likelihood principle and two-way factor associations were verified through Fisher's exact statistical hypothesis tests for count data. The effect of sugar intake on caries incidence is mediated by oral hygiene; for caries incidence, oral hygiene quality is more relevant than toothbrushing time; the effect of pacifier on caries incidence is statistically significant only when considered in combination with breastfeeding time. Among behavioural ECC risk factors, the quality of oral hygiene, and not the toothbrushing frequency, is a primary factor that modulates the sugar intake in his primary role of the ECC developer. School-based oral health programs for ECC prevention should be improved with supervised toothbrushing program. UGM analysis could improve the school-based oral health programs with more effective and efficient prevention strategies based on the hierarchical interactions among the ECC risk factors. Oral hygiene plays a pivotal role in early childhood caries and can modulate positively or negatively their development. Supervised toothbrushing is a crucial intervention to be included in the daily educational and clinical practice and in the school-based oral health promotion programs. Trial registration: Clinical trial registration number: NCT02798809.

Pulp chamber temperature changes and enamel surface analysis during orthodontic composite removal using 3 different burs in a repeatable approach: an experimental study.

BACKGROUND: During the debonding phase every clinician has to take care of preserving the enamel structure and tooth temperature. The objective of this study is to analyze in vitro the increase of the pulp chamber temperature and the wearing of enamel surface, during adhesive removal after debonding. METHODS: 60 extracted human teeth were selected. An orthodontic bracket was bonded on each tooth and after bracket removal, intraoral scanner pictures were used to evaluate ARI for each tooth. 3 different burs were tested: Tungsten-carbide multiple blade, Arkansas stone and Ceramic bur. A mechanical arm controlled by a dedicated software was used to reproduce a repeatable act of composite removal. To analyze in vitro the pulp chamber temperature during the composite removal procedure, teeth were treated endodontically placing a thermocouple through the root canal from the apex. A software registered temperature changes in a continuous manner. The enamel surface of every tooth was tested after the removal of composite with an optical stereoscopic microscope. RESULTS: An association existed between maximum internal pulp chamber temperature variation and irrigation (P-value < 0.0001) and between maximum internal pulp chamber temperature variation and bur type (P-value = 0.0133), with a significantly lower temperature increase produced by the Arkansas bur. A significant difference among groups was detected for ESI and EDI assessment (P-value = 0.002, P-value = 0.010). CONCLUSIONS: Considering the initial setup, temperature variation analysis showed more conservative results using the Arkansas burs with irrigation. ESI and EDI indexes showed significant enamel surface damage using Tungsten-carbide burs.

Accuracy of direct insertion of TADs in the anterior palate with respect to a 3D-assisted digital insertion virtual planning.

BACKGROUND: Direct and 3D-assisted methods are an available alternative when inserting temporary anchorage devices (TADs) in the anterior palate for orthodontic anchorage. This study aimed to evaluate the differences between a planned insertion versus a direct method on digital models. SETTINGS AND SAMPLE POPULATION: Seventy TADs were inserted by the direct insertion method in 35 patients who needed palatal TADs for orthodontic anchorage. For each patient, placement was independently planned by the superimposition of lateral cephalograms and corresponding plaster models. After mini-implant placement, impressions were taken with scanbodies. For the measurement of both linear and angle deviations, virtual planning models and postoperative oral scans were compared using 3D software for automatic surface registration and calculations. RESULTS: Comparing TADs positioned by the direct method and the digitally planned method, a mean linear distance was found of 2.54 ± 1.51 mm in the occlusal view and 2.41 ± 1.33 mm in the sagittal view. No significant difference has been found between TADs positioned in the right and left palatal sides. A mean distance of 7.65 ± 2.16 mm was found between the tip of the digitally planned TAD and the central incisors root apex. CONCLUSIONS: Both direct and 3D-assisted TAD insertion methods are safe and accurate in the anterior palate. However, the use of insertion guides facilitates TAD insertion, allowing less-experienced clinicians to use palatal implants.

Orthodontic treatment for posterior crossbites.

BACKGROUND: A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. The prevalence of posterior crossbite is around 4% and 17% of children and adolescents in Europe and America, respectively. Several treatments have been recommended to correct this problem, which is related to such dental issues as tooth attrition, abnormal development of the jaws, joint problems, and imbalanced facial appearance. Treatments involve expanding the upper jaw with an orthodontic appliance, which can be fixed (e.g. quad-helix) or removable (e.g. expansion plate). This is the third update of a Cochrane review first published in 2001. OBJECTIVES: To assess the effects of different orthodontic treatments for posterior crossbites. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 8 April 2021 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) of orthodontic treatment for posterior crossbites in children and adults. DATA COLLECTION AND ANALYSIS: Two review authors, independently and in duplicate, screened the results of the electronic searches, extracted data, and assessed the risk of bias of the included studies. A third review author participated to resolve disagreements. We used risk ratios (RR) and 95% confidence intervals (CIs) to summarise dichotomous data (event), unless there were zero values in trial arms, in which case we used odds ratios (ORs). We used mean differences (MD) with 95% CIs to summarise continuous data. We performed meta-analyses using fixed-effect models. We used the GRADE approach to assess the certainty of the evidence for the main outcomes. MAIN RESULTS: We included 31 studies that randomised approximately 1410 participants. Eight studies were at low risk of bias, 15 were at high risk of bias, and eight were unclear. Intervention versus observation For children (age 7 to 11 years), quad-helix was beneficial for posterior crossbite correction compared to observation (OR 50.59, 95% CI 26.77 to 95.60; 3 studies, 149 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 4.71 mm, 95% CI 4.31 to 5.10; 3 studies, 146 participants; moderate-certainty evidence). For children, expansion plates were also beneficial for posterior crossbite correction compared to observation (OR 25.26, 95% CI 13.08 to 48.77; 3 studies, 148 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 3.30 mm, 95% CI 2.88 to 3.73; 3 studies, 145 participants, 3 studies; moderate-certainty evidence). In addition, expansion plates resulted in higher inter-canine distances (MD 2.59 mm, 95% CI 2.18 to 3.01; 3 studies, 145 participants; moderate-certainty evidence). The use of Hyrax is probably effective for correcting posterior crossbite compared to observation (OR 48.02, 95% CI 21.58 to 106.87; 93 participants, 3 studies; moderate-certainty evidence). Two of the studies focused on adolescents (age 12 to 16 years) and found that Hyrax increased the inter-molar distance compared with observation (MD 5.80, 95% CI 5.15 to 6.45; 2 studies, 72 participants; moderate-certainty evidence). Intervention A versus intervention B When comparing quad-helix with expansion plates in children, quad-helix was more effective for posterior crossbite correction (RR 1.29, 95% CI 1.13 to 1.46; 3 studies, 151 participants; moderate-certainty evidence), final inter-molar distance (MD 1.48 mm, 95% CI 0.91 mm to 2.04 mm; 3 studies, 151 participants; high-certainty evidence), inter-canine distance (0.59 mm higher (95% CI 0.09 mm  to 1.08 mm; 3 studies, 151 participants; low-certainty evidence) and length of treatment (MD -3.15 months, 95% CI -4.04 to -2.25; 3 studies, 148 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and Haas for posterior crossbite correction (RR 1.05, 95% CI 0.94 to 1.18; 3 studies, 83 participants; moderate-certainty evidence) or inter-molar distance (MD -0.15 mm, 95% CI -0.86 mm to 0.56 mm; 2 studies of adolescents, 46 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and tooth-bone-borne expansion for crossbite correction (RR 1.02, 95% CI 0.92 to 1.12; I² = 0%; 3 studies, 120 participants; low-certainty evidence) or inter-molar distance (MD -0.66 mm, 95% CI -1.36 mm to 0.04 mm; I² = 0%; 2 studies, 65 participants; low-certainty evidence).  There was no evidence of a difference between Hyrax with bone-borne expansion for posterior crossbite correction (RR 1.00, 95% CI 0.94 to 1.07; I² = 0%; 2 studies of adolescents, 81 participants; low-certainty evidence) or inter-molar distance (MD -0.14 mm, 95% CI -0.85 mm to 0.57 mm; I² = 0%; 2 studies, 81 participants; low-certainty evidence).  AUTHORS' CONCLUSIONS: For children in the early mixed dentition stage (age 7 to 11 years old), quad-helix and expansion plates are more beneficial than no treatment for correcting posterior crossbites. Expansion plates also increase the inter-canine distance. Quad-helix is more effective than expansion plates for correcting posterior crossbite and increasing inter-molar distance. Treatment duration is shorter with quad-helix than expansion plates. For adolescents in permanent dentition (age 12 to 16 years old), Hyrax and Haas are similar for posterior crossbite correction and increasing the inter-molar distance. The remaining evidence was insufficient to draw any robust conclusions for the efficacy of posterior crossbite correction.

Skeletal and dental changes after maxillary expansion with a bone-borne appliance in young and late adolescent patients.

INTRODUCTION: Rapid palatal expansion is a common therapy during orthodontic treatment and could be a preliminary step for correcting different malocclusions; furthermore, this treatment could be necessary at any age. Different anchorage approaches have been proposed to obtain an effective skeletal result, although every device produces both dental and skeletal effects. This study aimed to compare the dentoskeletal effects of a bone-borne palatal expander considering 2 groups of patients of different ages. METHODS: Twenty-four patients consecutively treated were included in the study; patients were divided into 2 groups according to their age: group 1 with age ≤16 years and group 2 patients >16 years. All patients had a preexpansion cone-beam computed tomography scan; a second scan was required at the end of activations. All patients received a bone-borne appliance anchored on 4 miniscrews. RESULTS: Significant intragroup differences were found for maxillary width and dental diameters. No significant differences were found between groups with regard to longitudinal changes, except for the maxillary right plane. CONCLUSIONS: The use of bone-borne maxillary expansion was effective in generating palatal widening both in growing and young adult patients. No significant skeletal or dental differences were found between groups.

Maximum insertion torque loss after miniscrew placement in orthodontic patients: A randomized controlled trial.

OBJECTIVES: To compare torque recordings of immediately loaded orthodontic miniscrews between insertion time and different post-placement timepoints (2 weeks, 4 weeks and removal time, respectively). SETTING AND SAMPLE POPULATION: Parallel trial with an allocation ratio of 1:1. Eligibility criteria were needs of fixed orthodontic treatment, no systemic disease and absence of using drugs altering bone metabolism. MATERIAL AND METHODS: Patients received miniscrews, 2.0 mm diameter and 10 mm length. All miniscrews underwent inter-radicular placement, and they were placed in the maxilla or in the mandible, palatally or buccally. No pre-drilling was performed. Miniscrews were loaded immediately after the insertion and were used for distalization, intrusion, extrusion, mesialization or indirect anchorage. Patients were randomly divided into three groups. For each patient, Maximum Insertion Torque (MIT) was evaluated at baseline. MIT was measured again after 2 weeks and after 4 weeks by tightening the screw a quarter of turn in Groups 1 and 2, respectively. At the end of the treatment, maximal removal torque was evaluated in Group 3. Torque variation with respect to insertion time was considered as the primary outcome. Baseline and longitudinal differences were tested using the linear mixed-effects (LME) model. RESULTS: Forty seven patients and 74 miniscrews were followed up. An association existed between maximum insertion torque and the observation time. A torque decrease of 26.9% and 30% after 2 weeks was observed for mandibular and maxillary miniscrews, respectively. After 1 month, torque values were similar to the baseline records. The overall success rate was 79.7%. No serious harm was observed. CONCLUSIONS: Maximum insertion torque undergoes a loss during the first 2 weeks, and its values may depend on the insertion site and the anchorage purpose. Removal torque value is almost the same as the initial torque after 1 month.

Maxillary dento-skeletal outcomes after orthopedic forward (class III) and backward (class II) traction in growing subjects.

BACKGROUND: This retrospective study investigated the treatment effects produced by two orthopedic appliances, an extraoral orthopedic traction on Stephenson plate (SP) in skeletal Class II malocclusion and Delaire Facial Mask (FM) in skeletal Class III malocclusion. METHODS: FM Group comprised 25 patients (13 males; 12 females, mean age 9.3 years, CS 1-2) undergoing Delaire Facial Mask therapy (mean treatment duration 1.5 years ± 1.2, 700-800 gr per side). SP Group comprised 24 patients (9 males; 15 females, mean age 10.5 years ± 1.9, CS 1-3) treated with extraoral orthopedic traction on Stephenson plate (mean treatment duration 1.6 years ± 0.8, 700-900 gr per side). For all subjects lateral cephalograms before (T0) and after (T1) therapy were obtained and traced. Descriptive statistics, t-test and Shapiro-Wilks test were calculated for each variable. RESULTS: A mesial movement of the maxillary bone of 2.4 mm in the FM group and a distal movement in the PS group (0.4 mm) was found. SNA° was reduced 1.4° after SP and increased 0.7° after FM. The overjet decreased by 4 mm after SP, while it grew after FM by 2.4 mm, as well as molars relationships (4.5 vs. 0.8 mm). CONCLUSIONS: Facemask induced greater skeletal movements than extraoral traction on Stephenson plate. PS produced a limited downward movement of the whole maxilla together with notable incisors and molars back corrections. Based on our results, it could be speculated that orthopedic mesial traction of maxillary bone may result easier than the distal movement.

Palatal changes in crossbite patients treated with rapid maxillary expansion vs untreated ones: A geometric morphometric study.

OBJECTIVE: The present study aimed to analyse palatal changes due to rapid maxillary expansion (RME) by using modern geometric morphometric analysis (GMA) on 3D models. SETTINGS AND SAMPLE POPULATION: Forty children with posterior crossbite and maxillary deficiency were selected for this study. Twenty children were treated with RME (mean age 7.4 ± 0.8 years), whereas 20 children were not treated (mean age 7.2 ± 1.1 years). MATERIALS AND METHODS: In the treated group, RME screw was activated until overcorrection was achieved and the RME appliance remained in place for 11 months. Digital dental casts were recorded before treatment and 1 year after the end of active treatment. GMA was performed to compare shape and dimensional variations among groups (between-group principal component analysis). RESULTS: All children in the treated group achieved crossbite correction. None of the control group children achieved crossbite self-correction. No significant shape and dimensional changes were noted in the control group after 1 year. On the other hand, significant shape and dimensional changes were noted in the treated group after 1 year (P < .05). Most of the shape changes in the treated group were similar but more pronounced compared to those observed in the control group. All major changes in palatal morphology occurred on the lateral sides of the palatal vault (widening) and at the height (shortening). Some shape changes were observed in the treated group alone. CONCLUSIONS: Application of GMA to evaluate the effects of RME in crossbite patients revealed significant changes in palatal morphology compared with the absence of changes in the control group.

Upper canine response to rapid maxillary expander anchored to deciduous vs. permanent molars.

PURPOSE: To understand whether two different designs of Haas-type rapid maxillary expander (H­RME) might have a different influence on canine eruption. PATIENTS AND METHODS: In all, 108 subjects seeking orthodontic treatment were selected and divided into two groups-H­RME with bands on the upper second deciduous molars (GrE), H­RME with bands on the upper first permanent molars (Gr6)-and were also compared to an historical untreated control group (CG) of 29 subjects. Panoramic x­rays (OPG) were performed before and after RME (T0-T1: 16 ± 7 months) and the upper canine angulation to the midline ("α" angle) was measured on both pre- and posttreatment OPG. RESULTS: A significant improvement of the canine position (decrease of the α angle) following RME in subjects with mixed dentition was reported in both treated groups, although the different design of the RME did not significantly affect canine angulation. Canine angulation in untreated subjects with transversal discrepancy did not improve significantly. CONCLUSION: Using RME in the early mixed dentition appears to be an effective procedure to increase the rate of eruption of maxillary canines, but the position of the bands on the upper second deciduous molars or on the upper first permanent molars and the significant different expansion of the upper dental arch at the canine level does not significantly influence the canine angulation following early treatment therapy.

Long-term dentoskeletal changes of class II growing patients' treatment with the propulseur universal light appliance. A prospective controlled study.

BACKGROUND: Class II is one of the most common malocclusions. The prevailing aspect in Class II patients is a mandibular deficiency. Various removable and fixed functional therapies are used in order to enhance the mandibular growth or position. The aim of this prospectively controlled study was to evaluate long-term dentoskeletal changes obtained by a functional appliance for Class II. METHODS: Prospective controlled study, based on a sample size calculation. 26 Class II Division 1 patients (11.8±1.5 years) were consecutively treated with the propulseur universal light (PUL) appliance and a multi bracket appliance (PG), they were compared to a sample of 26 Class II untreated patients (11.5±0.8 years) (CG). Lateral cephalograms were taken before and after the PUL therapy, and after multibracket treatment. Interaction analysis was carried out to test whether the PUL parameters in treatment groups were different according to the acquisition times, using the Linear Mixed-Effects Model. RESULTS: Significant ANB, Overjet and WITS differences existed in treatment groups according to the time. In particular, comparing to T1 vs. T0, the relative difference (RD) means in the control group were -0.34, -0.31 and 0.17 for ANB, Overjet and WITS, respectively. The corresponding RD means in the treated group PG were -1.58, -4.27 and -2.38. Comparing to T2 vs. T0, the RD means in the control group were -0.36, -0.51 and 0.63 for ANB, Overjet and WITS, respectively. While the corresponding RD means in the treated group were -2.08, -5.12 and -2.50. CONCLUSIONS: The PUL appliance successfully corrected class II malocclusion. The long term correction was mainly due to dentoalveolar effects: therapy success was 91% for overjet correction and 76% for ANB correction. During the post functional appliance period, overjet was stable in 77% of the treated subjects, and ANB in 74% of the treated subjects.

A multicenter, prospective, randomized trial of pain and discomfort during maxillary expansion: Leaf expander versus hyrax expander.

BACKGROUND: Pain suffered by the young patient is the most frequent symptom during orthodontic treatment and is the one that most frightens children and causes worry in their families. AIM: To investigate pain perception and function impairment during the first week of activation of two palatal expansion screws. DESIGN: A total of 101 subjects were randomly divided into two groups: RME group included patients treated with the standard hyrax expansion screw and LEAF group included patients treated with Leaf Expander appliance. Pain intensity was assessed via the Wong-Baker scale. A questionnaire on oral function impairments was also compiled by the patients. RESULTS: The Pain Scale analysis showed that patients in the RME group suffered from a significantly higher level of pain than those in the LEAF group (88.6% vs 25%, P < .01). RME group showed highest pain indexes from day 1 to day 4 (51.4% RME vs 9.7% LEAF suffered at least once from strong pain in the first 4 days, P < .01). Furthermore, oral functions were similarly affected in both groups. CONCLUSIONS: Pain reported during maxillary arch expansion is influenced by clinical activation protocol and by the screw type. Patients treated with Leaf Expander reported significantly lower pain level in the first 7 days of treatment.

Herbst appliance anchored to miniscrews in the upper and lower arches vs standard Herbst: A pilot study.

INTRODUCTION: The aim of this pilot study was to present the preliminary results of Class II malocclusion treatment using a skeletally anchored Herbst appliance with miniscrews inserted in the maxillary and mandibular arches to improve anchorage control and skeletal effects. METHODS: The treatment group (TG) consisted of 13 patients (10 males [M], 3 females [F]; mean age of 12.8 years) with Class II Division 1 malocclusion who were treated with the Herbst appliance and miniscrews inserted in the maxillary and mandibular arches. They were compared with a control group (CG) of 13 patients (10 F, 3 M, mean age of 12.2 years) with Class II Division 1 malocclusion treated with the standard Herbst appliance without miniscrews. Lateral cephalograms were taken before and after Herbst treatment, and cephalometric analysis was performed. RESULTS: In the TG group SNB (°) increased by 2.9°, whereas in CG group SNB (°) increased by 1.1° (P = 0.017). ANB (°) decreased in both groups: -3.3° in the TG group vs -1.3° in the CG group (P = 0.014). Pg-OLp distance increased in both groups: 5.70 mm in the TG group and 0.8 mm in the CG group (P = 0.022). Mandibular incisors proclined 1.6° in the TG group and 3.7° in the CG group. CONCLUSIONS: Herbst treatment reinforced with 4 miniscrews (2 in each arch) increased the orthopedic effect of treatment in growing patients with Class II malocclusion.

Torque efficiency of a customized lingual appliance : Performance of wires with three different ligature systems.

PURPOSE: Torque control in lingual orthodontics is key to obtain optimal esthetic results. The aim of this in vitro experimental study was to verify the efficiency of the ligature-archwire-slot system in torque control using a customized lingual appliance. METHODS: An idealized cast with eight extracted human teeth was created and a set of customized lingual brackets was obtained. Tests were performed with the following wires: 0.016â€³â€¯× 0.022″ nickel-titanium (NiTi), 0.016â€³â€¯× 0.024″ stainless steel (SS), 0.017â€³â€¯× 0.025″ ßIII titanium (ßIIITi), 0.0182â€³â€¯× 0.0182″ ßIIITi, 0.018â€³â€¯× 0.025″ SS, 0.018â€³â€¯× 0.025″ NiTi, 0.018â€³â€¯× 0.025″ ßIIITi, and three types of ligatures were tested using a universal testing machine to calculate the efficiency in torque control. A blind statistical analysis was performed. RESULTS: Based on post hoc multiple comparisons, differences were found for two of the three ligatures when using the 0.016â€³â€¯× 0.022″ NiTi wires (p < 0.001 for both ligatures). When considering all ligatures, 0.018â€³â€¯× 0.025″ SS and 0.018â€³â€¯× 0.025″ ßIIITi were significantly different from all other wires (p < 0.001 in all cases). With a moment of 5 Nmm, the 0.016â€³â€¯× 0.022″ NiTi wire developed median angles of 26.7, 29.8, and 38.7° with the three ligatures, respectively, while the 0.018â€³â€¯× 0.025″ SS developed median angles of 12.9, 10.7, and 12.7°, respectively. CONCLUSIONS: The ligature type and geometry did not affect the efficiency of torque control, except for the 0.016â€³â€¯× 0.022″ NiTi wire. The wires generating the greatest moments were the 0.018â€³â€¯× 0.025″ SS and 0.018â€³â€¯× 0.025″ ßIIITi.

Non-extraction and multiloop edgewise technique versus orthognathic surgery and fixed appliance in adult class II patients: a cephalometric comparative study.

BACKGROUND: An alternative approach to surgery for treating class II adult borderline patients is the non-extraction and multiloop edgewise archwire (MEAW) technique. The aim of the present study is to compare dentoskeletal effects of the orthognathic surgery with the MEAW technique. METHODS: Thirteen adults (ten women, three men; mean age, 27.8 years) were consecutively treated using the MEAW approach. The control group was made of 13 adults (nine women, four men; mean age, 26.2 years) treated by orthognathic surgery and the multibracket appliance before and after surgery. Lateral headfilms before and after all the treatments were traced for linear and angular measurements, and data were blindly analyzed. ANOVA was conducted to compare any difference over time between the two treatments. Differences over time for each variable, separately for surgery and MEAW, were assessed by Wilcoxon test. RESULTS: No significant differences between the two groups were detected at baseline. Both treatments were effective in correcting dental discrepancies. A significant difference over time between the two treatments was found in several cephalometric measurements. CONCLUSIONS: Considering the limits of the present sample the following conclusion emerged: in the MEAW group, the malocclusion correction was predominantly dentoalveolar, and a significant profile change was observed. Significant skeletal and occlusal plane changes were obtained with the orthognathic surgery approach.

Efficiency in the correction of Class II division 1 malocclusions with prominent upper incisors and increased overjet: a comparison between two methods.

BACKGROUND: The aim of the present study was to evaluate the efficiency and effectiveness of high-pull traction on a Stephenson plate as well as cervical headgear treatments in Class II Division 1 growing subjects with prominent upper teeth and an increased overjet. METHODS: A prospective study was undertaken, involving participants who underwent maxillary correction of Class II malocclusions. Twenty-three patients (Stephenson plate group, SPG, mean age 10.4±0.9 years) were treated and compared with 24 subjects treated with headgear (HGG, mean age 9.6±1.2 years). Lateral cephalograms were analysed using Jarabak and Pancherz analysis. Shapiro-Wilk's and Student's t tests were applied. RESULTS: The SPG showed significant decreases in the overjet (-4.1 versus -0.8 mm) and molar relationship (-6.1 versus -1.5 mm). A significant upper-incisor correction was found in SPG (1/SpP -10.3° versus + 2.2°). SNA (-1.4 versus 0.3°) and WITS (-1 versus 0.3 mm) were reduced in SPG, showing a partial maxillary restraint. In SPG, the overjet correction (4.1 mm) was mainly due to the dental component (65.9%) and occurred almost completely in the maxilla (92.7%); the molar relationships improvement of 6.1 mm was mainly dental (77%); in HGG, the reduction of the overjet was limited (-0.8 mm), and the skeletal maxillary contribution was negligible. CONCLUSIONS: The high-pull traction on the Stephenson plate was more efficient and effective than HG in the treatment of Class II dentoskeletal malocclusions with prominent upper teeth and a severe overjet; the overjet reduction was obtained at approximately 6 months, contributing to the substantial Class II correction.

On the stability efficiency of anchorage self-tapping screws: Ex vivo experiments on miniscrew implants used in orthodontics.

BACKGROUND: The clinical success of orthodontic miniscrews is strictly related to primary stability, which depends on bone viscoelastic properties too. In this study, we evaluated the short time mechanical response of native bone to miniscrews, by a laboratory test based on dynamic loading. METHODS: Thirty-six segments of porcine ribs were first scanned by cone-beam computerized tomography to obtain insertion-site cortical thickness, cortical and marrow bone density. Twelve different types of miniscrews were implanted in the bone samples to evaluate the elastic compliance of the implants in response to a point force applied at the screw head normally to the screw axis. The compliance was measured dynamically in a Dynamic Mechanical Analysis apparatus as the Fourier Response Function between the signals of displacement and force. The measurements were repeated in five days successive to the insertion of the miniscrew. FINDINGS: The elastic compliance was positively related to observation timepoints, but it was not related neither to the screw type nor to the value of the insertion torque. INTERPRETATION: Stability behavior is significantly related to the short time response of native bone rather than to the screw design or the insertion torque values.

Trends in Early Childhood Caries: An Italian Perspective.

PURPOSE: To evaluate the prevalence of early childhood caries (ECC) and severe ECC (S-ECC) among Italian preschool children and its predictors regarding children's lifestyle. MATERIALS AND METHODS: A cross-sectional study was carried out involving 563 preschool children. A questionnaire for children's parents and clinical examinations were conducted by calibrated, blinded examiners. The odds ratios (OR) for ECC or S-ECC and co-presence of risk factors were calculated using univariate and multivariate models. Statistical significance was set at p < 0.05 in all analyses. RESULTS: The prevalence of ECC and S-ECC was 14.4% and 5.9%, respectively. According to the multivariate analysis, the predictors for caries were (p < 0.05): age (OR = 2.5; 95% CI = 1.36 - 4.52), non-Italian ethnic origin (OR = 4.3; 95% CI = 2.83 - 7.37), consumption of sugary beverages more than once per day (OR = 2.1; 95% CI = 1.21 - 5.26) and having inadequate oral hygiene status (OR = 3.6; 95% CI = 2.01 - 5.83). CONCLUSIONS: Dietary habits and dental care are important environmental contributing factors in the development of caries in preschool children. Oral health promotion should include an oral hygiene instruction programme and dietary guidelines focused on daily sugar intake for the preschool children themselves as well as for their parents.

Work-related traumatic dental injuries: Prevalence, characteristics and risk factors.

BACKGROUND/AIMS: The prevalence of work-related oral trauma is underestimated because minor dental injuries are often not reported in patients with several injuries in different parts of the body. In addition, little data are available regarding their characteristics. The aim of this epidemiological study was to determine the prevalence, types, and characteristics of occupational traumatic dental injuries (TDIs) in a large working community. MATERIALS AND METHODS: Work-related TDIs that occurred during the period between 2011 and 2013 in the District of Genoa (Northwest of Italy, 0.86 million inhabitants) were analyzed. Patients' data were obtained from the National Institute for Insurance against Accidents at Work database. RESULTS: During the 2 year period, 112 TDIs (345 traumatized teeth) were recorded. The prevalence was 5.6‰ of the total amount of occupational trauma. The highest prevalence was found in the fourth and fifth decades of life (OR=3.6, P < .001), and males were injured more often than females (70.5% vs 29.5%, OR=2.8, P < .001). Service and office workers represented 52% of the sample, and construction/farm/factory workers and craftsmen were 48%. TDIs involved only teeth and surrounding tissue in 66% of cases, or in combination with another maxillofacial injury in 34%. They were statistically associated with construction/farm/factory workers group (Chi squared P < .01). Crown fracture was recorded in 34.5% of cases, subluxation/luxation in 10.7%, avulsion in 9%, root fracture in 3.8%, and concussion in 3.5%. Thirty-two subjects (28.6%, 133 teeth, OR=4.3, P < .001) presented at least 1 traumatized tooth with previous dental treatment. Among 212 (61.4%) traumatized teeth, 67.5% were upper incisors, 17.5% were lower incisors, 3.3% were upper canines, 1.9% were lower canines, and 9.9% were bicuspids and molars. CONCLUSIONS: Work-related TDIs had a low overall prevalence, and fractures were the most frequent dental injury. Age, gender, and preexisting dental treatments represented risk factors for work-related TDIs.